Korean Lash Lift / Brow Lamination + Wax + Tint Consent/Consultation Form
Name
First Name
Last Name
Phone Number
Format: (000) 000-0000.
Email
example@example.com
Brow and Lash History
Have you ever had a KLL or your brows laminated? If yes, Have you had an adverse reaction? If yes, please explain:
Have you ever had an allergic reaction to hair perming products? If yes, please explain:
Are your eyebrows microbladed? If yes, when did you get them done?
Have you recently bleached or tinted your eyebrows?
Yes
No
General Health
Are you currently pregnant or breastfeeding?
Yes
No
Are you currently using Retinol, or taking Acutane or similar medications?
Yes
No
Do you have any of the following conditions? (Please select all that apply):
Eczema
Psoriasis around the eye
Recent eye surgery
Recent eye infection
Sensitive skin
Sunburn
Alopecia
Other
Please list any illness or condition you are currently being treated by a physician for:
Although every precaution will be taken to ensure my safety and wellbeing before, during and after the brow lamination process, I am aware of the following information and possible risks:
I understand that during the treatment, injury is possible I will not hold the technician or business performing this service on me responsible in any way for any damages or issues that may arise as a result of having the brow lamination procedure performed on me.
I understand that some irritation, itching or burning may occur to the skin which comes in contact with the chemical agent.
I understand that an allergic reaction is possible.
I understand that it is imperative that I disclose all of the information requested on the Client Consent Form.
I understand that the brow lamination is the process of restructuring the brow hairs to keep them in a desired shape, but it is my responsibility to brush my brows daily to maintain the desired look.
I understand that I need to keep my eyebrows and eyelashes free of water for 48 hours after the service.
I understand a Korean Lash Lift is a semi-permanent treatment that uses Cysteamine-based formulas to lift and curl natural lashes from the root.
Date Signed
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Client Signature
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